79 The impact of orthodontic treatment regulation in the german public health sector on the overuse of orthodontic services
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Notice bibliographique
Résumé
<h3>Objectives</h3> The provision of orthodontic (dental) care is part of the German Public Health sector comprising 90% of German population. The current regulations for the provision of orthodontic care in the public sector have been adopted in 2004 as a negotiation-process between providers and public health insurance companies without patient participation. To date patient-related data on the impact of the 2004 regulation on the quality and quantity of orthodontic services are lacking. In addition, patients (mostly adolescents) preferences and perceptions toward orthodontic treatment are almost unknown. Therefore, we first examined the content of the 2004 regulations in terms of formal criteria for treatment access, diagnostic and treatment guidelines as well as treatment duration. Secondly, we analyzed medical health record data to obtain information on real utilization of orthodontic services as diagnostic and treatment procedures. Finally we examined patient’s preferences and their role in the decision-making process. <h3>Method</h3> In the first stage we examined the formal criteria of the regulation of orthodontic services regarding treatment access, appropriateness criteria for diagnostic and treatment procedures as well as quality control. In the second stage we surveyed adolescents aged 10 to 14 years (n=2.991, 29% response rate) insured by a public health care insurance company before or at the beginning of treatment related to their perceptions of toward orthodontic treatment need using validated and standardized questionnaires. Finally, in the third stage we analyzed medical record data of patients undergoing orthodontic treatment from 2012–2017 (n=5.514) insured by a second, independent public health care insurance company to obtain quantitative data on the real utilization of detailed orthodontic services including diagnostic records, treatment procedures, costs as well as treatment duration time. <h3>Results</h3> Treatment guidelines adopted 2004 are mandatory for both providers and insurance companies. They regulate access through objective criteria and define criteria for the use of diagnostic and treatment procedures. Parallel guidelines adopted simultaneously regulate payment system and quality control. The described regulation has following impact on utilization of orthodontic services: Diagnostic procedures as panoramic X-ray and cephalograms were performed routinely (85%–90%) although their use is limited to defined diagnoses according to radiation guidelines and should not exceed 30%. About 64% of the patients received removable appliances despite their inappropriateness and inefficiency in comparison to fixed appliances. The mean treatment duration time was 36 months given that the published standard for a mean duration should be no longer than 18–20 months. Dentists were reported (81% of respondents) to be the primary driver for patients to start treatment. 93% of the patients reported to no complaints before starting treatment. <h3>Conclusions</h3> The use of inappropriate diagnostic and treatment procedures as well as prolonged treatment duration indicate overuse of orthodontic services in German public health sector. As diagnostic and treatment procedures are strictly regulated by treatment guidelines adopted by provides and public health insurance companies the overuse of orthodontic services seems to be driven by regulators, health authorities and providers.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle